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Background: In India, community-based acute lower respiratory infections (ALRI) burden studies are limited, hampering development of prevention and control strategies.Methods: We surveyed children <10 years old at home weekly from August 2012-August 2014, for cough, sore throat, rhinorrhoea, ear discharge, and shortness of breath. Symptomatic children were assessed for ALRI using World Health Organization definitions. Nasal and throat swabs were obtained from all ALRI cases and asymptomatic controls and tested using polymerase chain reaction for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza viruses (PIV), and influenza viruses (IV). We estimated adjusted odds ratios (aOR) using logistic regression to calculate etiologic fractions (EF). We multiplied agent-specific ALRI incidence rates by EF to calculate the adjusted incidence as episodes per child-year.Results: ALRI incidence was 0.19 (95% confidence interval (CI) = 0.18-0.20) episode per child-year. Association between virus and ALRI was strongest for RSV (aOR = 15.9; 95% CI = 7.3-34.7; EF = 94%) and least for IV (aOR = 4.6; 95% CI = 2.0-10.6; EF = 78%). Adjusted agent-specific ALRI incidences were RSV (0.03, 95% CI = 0.02-0.03), hMPV (0.02, 95% CI = 0.01-0.02), PIV (0.02, 95% CI = 0.01-0.02), and IV (0.01, 95% CI = 0.01-0.01) episode per child-year.Conclusions: ALRI among children in rural India was high; RSV was a significant contributor. [ABSTRACT FROM AUTHOR]

Acute lower respiratory infections (ALRI) are a leading cause of morbidity and mortality globally, with most ALRI deaths occurring in children in developing countries. Computational models can be used to test the efficacy of respiratory infection prevention interventions, but require data on social mixing patterns, which are sparse in developing countries. We describe social mixing patterns among a rural community in northern India. During October 2015-February 2016, trained field workers conducted cross-sectional face-to-face standardized surveys in a convenience sample of 330 households in Faridabad District, Haryana State, India. Respondents were asked about the number, duration, and setting of social interactions during the previous 24 hours. Responses were compared by age and gender. Among the 3083 residents who were approached, 2943 (96%) participated, of whom 51% were male and the median age was 22 years (interquartile range (IQR) 9–37). Respondents reported contact (defined as having had a face-to-face conversation within 3 feet, which may or may not have included physical contact) with a median of 17 (IQR 12–25) people during the preceding 24 hours. Median total contact time per person was 36 person-hours (IQR 26–52). Female older children and adults had significantly fewer contacts than males of similar age (Kruskal-Wallis χ2 = 226.59, p<0.001), but spent a longer duration in contact with young children (Kruskal-Wallis χ2 = 27.26, p<0.001), suggesting a potentially complex pattern of differential risk of infection between genders. After controlling for household size and day of the week, respondent age was significantly associated with number and duration of contacts. These findings can be used to model the impact of interventions to reduce lower respiratory tract infections in India. [ABSTRACT FROM AUTHOR]

A systematic search was carried out in the databases of Pubmed, Indmed and Mausam for articles on the effect of ambient temperature on health. Relevant data were extracted using a standard data abstraction form by two authors independently. The overall effects of ambient air temperature are reported as odds ratio (OR) and 95% confidence intervals (CIs) on mortality. Of 812 records identified, only seven were included in the final review as per pre-defined criteria. An increase in the all-cause mortality rate of 41% are reported during a heat wave in India. Risk ratios for all-cause mortality was in the range of 1.7-2.1. The dose-response relationship of ambient temperature and all-cause mortality and cardiovascular diseases are been reported. Current evidence on the effect of ambient temperature and health is sufficient to initiate an integrated response from policy makers, climate scientists and public health practitioners in India. Continued advocacy and generation of more robust evidence is needed. [ABSTRACT FROM AUTHOR]

Objective: To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. Methods: During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. Findings: The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y) and identified 150 (5%, 95%CI: 4–6) ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32–44). Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8–11) had laboratory-confirmed influenza (A (H3N2) = 72; B = 54). After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children <5 years (13; 95% CI: 4–29) and persons≥60 years (11; 95%CI: 2–30). Conclusion: We present a novel way to use HUS and CBS data to generate estimates of community burden of influenza. Although the confidence intervals overlapped considerably, higher point estimates for burden among young children and older adults shows the utility for exploring the value of influenza vaccination among target groups. [ABSTRACT FROM AUTHOR]

Background: Despite acute respiratory infections being a major cause of death among children in developing countries including India, there is a lack of community-based studies that document its burden and aetiology.Methods: A dynamic cohort of children aged 0-10 years was established in four villages in a north Indian state of Haryana from August 2012 onwards. Trained health workers conducted weekly home visits to screen children for acute respiratory infection (ARI) defined as one of the following: cough, sore throat, nasal congestion, earache/discharge, or breathing difficulty. Nurses clinically assessed these children to grade disease severity based on standard age-specific guidelines into acute upper or lower respiratory infection (AURI or ALRI) and collected nasal/throat swabs for pathogen testing.Results: Our first year results show that ARI incidence in 0-10 years of age was 5.9 (5.8-6.0) per child-year with minimal gender difference, the ALRI incidence in the under-five age group was higher among boys (0.43; 0.39-0.49) as compared to girls (0.31; 0.26-0.35) per child year. Boys had 2.4 times higher ARI-related hospitalization rate as compared to girls.Conclusion: ARI impose a significant burden on the children of this cohort. This study platform aims to provide better evidence for prevention and control of pneumonia in developing countries. [ABSTRACT FROM AUTHOR]

Background We assessed the differential and sequential effects of a Government of India conditional cash transfer scheme for the socio-economically disadvantaged (Janani Suraksha Yojana; JSY) and the strengthening of the primary health centre (PHC) network to provide 24/7 obstetric care in promoting institutional deliveries.Methods This study used 7796 births from the Ballabgarh Health and Demographic Surveillance Site between April 2006 and March 2010 when both schemes were implemented in a staggered manner. The multiple baseline design took advantage of interventions separated by time and geographical zone to compute difference in differences in the rate of institutional deliveries. Logistic regression was used to estimate increases in the odds of institutional deliveries after adjustment for caste and maternal education.Results Compared with villages with poor access, institutional deliveries nearly doubled among villages with access to 24/7 delivery services; odds ratio (OR) 1.9 [95% confidence interval (CI): 1.3, 2.6]. Introduction of JSY in villages with poor access resulted in a 1.4-fold (95% CI: 1.1, 1.8) increase in institutional deliveries and a 1.1-fold (95% CI: 0.9, 1.4) increase in villages served by PHCs 24/7. However, the introduction of PHC 24/7 care to villages served by JSY doubled the rate of institutional deliveries; OR 2.1 (95% CI: 1.5, 2.8). Among the disadvantaged, institutional deliveries increased by 34.4%, compared with 24.8% among the non-disadvantaged. Introduction of PHC 24/7 care in this group increased institutional deliveries 4-fold; OR 4.2 (95% CI: 1.9, 9.0) compared with 3-fold for JSY alone; OR 3.2 (95% CI: 1.8, 5.6).Conclusions Both demand and supply side strategies are effective and promote equity. Improving service delivery in a population previously primed by demand side intervention appears to be the most useful. [ABSTRACT FROM AUTHOR]

The Ballabgarh Health and Demographic Surveillance System (HDSS), also known as the Comprehensive Rural Health Services Project (CRHSP) Ballabgarh, is located in north India and was established in 1961 to develop a model for rural health-care practice in India. In addition to demographic surveillance and community-based research, CRHSP Ballabgarh provides preventive, health-promotion, and curative services to its surrounding population. The population served by CRHSP Ballabgarh in 2011 was about 90 000. The system collects data for the entire population through fortnightly visits by health workers (HWs). The system’s data base is updated once every month and further updated with missing data and special morbidity surveillance data during the annual census. Since 1961, CRHSP Ballabgarh has collected demographic data, reproductive data, and health data about mothers and their children. More recently, the project began collecting data on diseases such as tuberculosis, and because of changes in life style it recently began collecting data about non-communicable diseases (NCD) and risk factors for NCDs. Nonetheless, an adverse sex ratio, with more boys than girls, and a stagnant neonatal mortality rate, remain major challenges in the population served by CRHSP Ballabgarh. The project shares data with different agencies for health-management purposes, which can be made available to bona fide researchers on receipt of a proposal (enquiries should be directed to: crhsp.ballabgarh@gmail.com); collaboration requests are welcome. [ABSTRACT FROM AUTHOR]

Objective: Clinical case definitions used for influenza surveillance among hospitalized patients vary and need systematic evaluation. Design, setting and sample: During July 2009-August 2011, we collected clinical data and specimens (nasal and throat swabs) from rural patients hospitalized for acute medical illnesses. Specimens were tested by rRT-PCR for influenza viruses. Main outcome measures: Case definitions evaluated the following: influenza-like illness (ILI: measured fever plus cough or sore throat); severe acute respiratory illness (SARI: ILI with difficulty breathing in ≥5 years, Integrated Management of Childhood Illness-defined pneumonia or severe pneumonia, or physician diagnosed lower respiratory infection in <5 years); acute respiratory infection (ARI: ≥1 of cough, nasal discharge, difficulty breathing or sore throat); febrile acute respiratory illness (FARI: fever plus either cough, sore throat, runny nose, difficulty breathing, or earache). Variants that included 'reported fever' and additional sign-symptom combinations were also evaluated. Results: We enrolled 1043 hospitalized patients, including 257 children <5 years of age (range 1 day-86 years). Seventy-four patients tested influenza virus positive (including 28 A(H1N1)pdm09). Sensitivity(95% CI) and specificity (95% CI) for influenza infection were 78% (67-87) and 60% (57-63) for ILI (measured/reported fever); 37% (26-49) and 78% (75-80) for SARI (measured/reported fever); 82% (72-90) and 57% (54-60) for FARI (measured/reported fever); 88% (78-94) and 45% (42-49) for ARI; and 74% (63-84) and 61% (58-64) for measured/reported fever plus cough. Case definitions including only measured fever had lower sensitivity. Conclusion: ILI and FARI with measured/reported fever provided good balance between sensitivity and specificity among hospitalized patients. The simpler case definition of measured/reported fever plus cough is suited for field surveillance. [ABSTRACT FROM AUTHOR]

Despite significant progress in medical research, cardiovascular diseases (CVDs) continue to be the largest contributors of morbidity and mortality both in developed and developing countries. The status of public health interventions related to CVDs prevention was reviewed to identify actions that are required to bridge the existing gap between the evidence and the policy. We used a framework comprising two steps - "bench to bedside" and from "bedside to community" to evaluate translational research. Available literature was reviewed to document the current status of CVD prevention and control at national level in India. Case studies of risk factor surveillance, tobacco control and blood pressure measurement were used to understand different aspects of translational research. National level initiatives in non-communicable diseases surveillance, prevention and control are a recent phenomena in India. The delay in translation of research to policy has occurred primarily at the second level, i.e., from 'bedside to community'. The possible reasons for this were: inappropriate perception of the problem by policy makers and programme managers, lack of global public health guidelines and tools, and inadequate nationally relevant research related to operationalization and cost of public health interventions. Public health fraternity, both nationally and internationally, needs to establish institutional mechanisms to strengthen human resource capacity to initiate and monitor the process of translational research in India. Larger public interest demands that focus should shift to overcoming the barriers at community level translation. Only this will ensure that the extraordinary scientific advances of this century are rapidly translated for the benefit of more than one billion Indians. [ABSTRACT FROM AUTHOR]

Summary: Background: Data on influenza illness rates with population denominators are needed to quantify overall morbidity and to prioritize public health intervention strategies. Methods: The rates of influenza A(H1N1)pdm09 infection during pandemic phases were determined in a longitudinal community cohort study as part of an influenza vaccine study in a rural community of North India. Results: During the 711 731 person-weeks of surveillance, a total of 1410/7571 (19%) febrile acute respiratory illness cases were positive for influenza. Of these, 749 (53%) were influenza A(H1N1)pdm09, 643 (46%) influenza B, and 18 (1%) influenza A (H3N2). The overall incidence rate of influenza-associated febrile acute respiratory illness was 128/1000 person-years. The incidence rates of influenza A(H1N1)pdm09 were high during both the pandemic phase (179/1000 person-years; November 2009 to January 2010) and post-pandemic phase (156/1000 person-years; August to October 2010), with children <18 years of age being at the greatest risk of influenza infection in the community. Conclusions: These findings provide important information for planning clinical and public health intervention strategies to mitigate the impact of influenza epidemics. [Copyright &y& Elsevier]